Ed Ikka Taipale et al

Zed Books, £16.95/$29.95, pp 652 

ISBN 1 85649 951 0

Rating:

Finland may be a small country without any enemies, but it has produced a rather huge book on health and conflict, which will be invaluable to health professionals and policy makers.

The recent surge (if a growing trickle can be called that) of interest in health issues arising out of conflict follows a brutal century, in which 107 million people have died as a direct result of war. This bookfrom the Finnish Physicians for Social Responsibilitycovers everything from the health effects of different arms systems, to the demographic and social consequences of war, to the concept of conflict prevention and management. But it is only part of the coordinated, systematic response to the health consequences of conflict that is needed from academics, non-governmental organisations, and others.

War or Health? is an apt title for the book. The volume is a testament to why health professionals should be among the leaders in preventing war. Fittingly, the opening paper by Christian Jennsen highlights the important role that doctors have played in antiwar efforts since the 19th century. It describes the activities of the German pathologist Rudolf Virchow, who opposed the "blood and iron" politics of Bismarck, up to the activities of the International Physicians for the Prevention of Nuclear War, whose work was so influential in raising the alarm over the buildup of nuclear arms.

But more needs to be done. Epidemiological monitoring of the effects of conflict is one of the technical tasks, as Jennifer Leaning and collaborators note. Most information currently comes from military databases, whose main purpose is to improve the killing power of forces. Humanitarian epidemiology will need to take place to prevent more horrific weaponry being developed. Progress has already been made in this area with the banning of blinding laser weapons.

With the numerous conflicts in the developing world in the 1990s, there could have been more on the connections between war, violence, and underdevelopment. The recent work by the economist Frances Stewart is a breakthrough in this field. There could also have been analysis of the mental health questions that arise from conflict. For example what drives people to terrorism? What kind of mind can devise such brutal killing machines as antipersonnel landmines? How can we better understand the forces that drive genocide?

This remarkable book deserves the bouquets thrown at it by World Health Organization director general Gro Harlem Brundtland and United Nations secretary general Kofi Annan. But as Meri Koivusalo's depressing paper points out, the UN's role as an arbiter in conflict issues is increasingly under threat. Its influence is shifting to the less representative and democratic forums of the G8 and NATO. War has been limited by the international agreements of the Geneva Conventions, the human rights covenants, and more recently the International Criminal Court. However, the international community (led by the UN) could impose further strictures on the actions that are currently permitted in war. Who knows, in the end war itself could be completely abolished. To this optimistic end, health professionals could sign up to a new campaign, the Movement for the Abolition of War, recently launched by Robert Hinde and Nobel peace laureate Joseph Rotblat. Read War or Health? and you will need no convincing.

Michael Rowson, director. 

Medact